Scientific study

A comparative review of the effectiveness of
hypnosis, an advanced method of hypnosis, and
other interventions used for the cessation of
by Michael O' Driscol B.Sc., M.Sc. (Oxon)
Contents
What's the problem?: Smoking - the biggest cause of preventable death in
2. Hypnosis and other interventions for smoking cessation .4
Effectiveness of hypnotherapy in bringing about smoking cessation compared
High quit rates for hypnosis compared to other methods .4
Other interventions for smoking cessation.6
(2) Non-nicotine Pharmacological treatments .7
(3) Intervention by health practitioners .8
(6) Other methods of facilitating smoking cessation.9
3. Tailored' hypnosis - taking it to the next level.10
For subjects treated with the standard technique: .15
For subjects treated with our technique:.15
Introduction
This paper presents the findings from a study looking at al methods of smoking
cessation, including standard hypnotherapy techniques and compares those to a
special y developed advanced method of hypnotherapy for smoking cessation; quit
rates are compared; some tentative concussions are suggested.
What's the problem?: Smoking—the biggest cause of preventable death in the
It is estimated that there are 1.1 bil ion smokers worldwide and that smoking-related
il ness costs the NHS £400m and kil s 111,0001 people a year in the UK. In view of the
human and financial costs of tobacco smoking it is not surprising that there is large
demand from individuals and from governments for products or techniques which may
help the cessation of smoking. The market for nicotine replacement products alone is
estimated at $1bn dol ars annual y and £80m per year in the UK.
Hypnosis and other interventions for smoking cessation
Effectiveness of hypnotherapy in bringing about smoking cessation compared to other
High quit rates for hypnosis compared to other methods
A larger meta-analysis of research into hypnosis to aid smoking cessation
(Chockalingam and Schmidt 1992) (48 studies, 6,020 subjects) found that the average
quit rate for those using hypnosis was 36%, making hypnosis the most effective method
found in this review with the exception of a programme which encouraged pulmonary
and cardiac patients to quit smoking using advice from their doctor (such subjects are
obviously atypical as they have life-threatening il nesses which are aggravated by
smoking and therefore these people have very strong incentives to quit).
% who quit subjects Hypnosis Effectiveness of different types of intervention to achieve smoking cessation adapted from data in Chockalingam and Schmidt (1992)
Law and Tang (1995) looked at 10 randomised trials, carried out between 1975 and
1988, of hypnosis in smoking cessation. They found that the effect of hypnosis was
highly statistical y significant2. The research they examined involved 646 subjects and
cessation rates at 6 months post-treatment ranged from 10% to 38% (the average
Type of intervention subjects Hypnosis Effectiveness of different types of intervention to achievesmoking cessation (adapted from data in Law and Tang 1995)
Table 2 (above) shows that the meta-analysis of Law and Tang confirms, to a large
extent, the meta-analysis of Chockalingam and Schmidt (1992); in both cases hypnosis
appears as the most effective form of intervention to achieve smoking cessation with
the exception of groups who are highly motivated to quit for medical reasons, such as
those with existing heart or pulmonary problems.
A more recent study, by Ahijevych et al (2000), produces a similar overal figure for the
success of hypnosis. This study looked at a randomly selected sample of 2,810
smokers who participated in single-session, group hypnotherapy smoking cessation
programs sponsored by the American Lung Association of Ohio. A randomly selected
sample of 452 participants completed telephone interviews 5 to 15 months after
attending a treatment session. 22% percent of participants reported not smoking during
2 Combined results were statistical y significant at the .001 level, meaning that there is less than a one in
a thousand chance that these results happened by chance.
Other interventions for smoking cessation
Although this can consist of gum, spray, tablets or patches, the latter are by far the most
popular form of nicotine replacement. Nicotine replacement patches became available
over the counter (without prescription) in the UK in November 1992, and became free
(the user only pays the prescription charge) to smokers in 2001, on condition that the
smoker's GP consider this form of therapy advisable. In effect this means that the UK
government has subsidised the use of nicotine replacement therapy, in the hope of
offsetting the huge annual costs of smoking-related diseases to the NHS. There is a
growing discussion about whether nicotine replacement therapy is an effective way of
The New Scientist (editorial comment: vol 137 issue 1860 Feb 93, p.3) points out that in
the U.S. patches are perceived as merely one component of a quitting programme -
manufacturers of NRT are in fact expressly forbidden to suggest that their products can
alone be a successful means to quitting smoking - no such regulation exists in the UK
as yet leading to what some people might feel is a misconception that patches alone
can result in successful cessation of smoking.
The evidence on the efficacy of NRT, considered alone, is fairly clear; it is better than
quitting without any form of intervention and support but only to a limited extent in
absolute terms (e.g. Hughes 1993). The meta-review of smoking cessation interventions
referred to previously (Law 1995) found that, for subjects3 who were recommended
nicotine gum or patches by their GP, without prior request from the subject for advice on
giving up smoking, the quit rates were 3% for gum and 4% for patches. Quit rates for
self-referred smokers (i.e. those specifical y consulting their GP for advice on giving up
smoking) were considerable higher at 11% (gum) and 13% (patches). The quit rates
using gum or patches, even amongst those who have specifical y come forward seeking
help in quitting, are many times lower than the quote rates which were found for
hypnotherapy in the same review, and are in fact amongst the least successful of al the
smoking cessation interventions which were reviewed. Tang et al (1994) claim that with
higher doses of nicotine replacement and more careful targeting of subjects based on
their current level of dependence, it may be possible to achieve a quit rate of one-third
Chockalingam and Schmidt (1992) found an average quit rate of 16% for the 4,866
subjects in 40 studies which looked at the efficacy of nicotine gum. This equates to less
than half the average quit rate achieved using hypnosis (36%), which they found in the
Davidson et al (1998) (in a study carried out after the two meta-analyses discussed
above) evaluated the efficacy and safety of nicotine patches in an over-the-counter
setting. They used a multi-site, double-blind, randomised, placebo-control ed design in a
trial of 6-week duration with 18 weeks of fol ow-up.
3 GP-initiated treatment was examined in 7146 subjects in 15 studies (gum) and 2597 subjects in 4
studies (patch); 3460 subjects in 13 studies (gum) and 2020 subjects in 10 studies who referred
The randomised sample consisted of 802 adults (mean age, 39 years) and was 89%
white and 54% female. A smoking history of at least 20 cigarettes per day for 1 year and
a score of 5 (on a 10-point scale) on a motivational assessment questionnaire were
required for enrolment. Post study fol ow-up was limited to those who had quit smoking
at the end of 6 weeks. Nicotine patches were provided at the shopping mal . Guidance
consisted only of package instructions and a smoking cessation self-help booklet. Quit
rates were defined as total abstinence from smoking for 4 consecutive weeks (treatment
weeks 3-6), post prevalence smoking status at week 6, or non-smoker at week 6 and
week 24 (6-month post quit date). Smoking status was assessed by diaries, and
verification for the first 2 quit rates was obtained by confirmation of carbon monoxide of
8 ppm4 or less in expired breath. Safety was evaluated by self-reported adverse events.
At 24 weeks, 8.2% of non-smokers in the active treatment group and 4.0% in the
placebo group remained non-smokers. The authors conclude that ‘.the nicotine patch
was used in an over-the-counter setting, quit rates were comparable to those reported
for medical settings. A 2:1 quit rate advantage was achieved at week 6 and was
maintained at 24 weeks. This 8% quit rate is in the range found in the studies already
It may be that, as Cepeda-Benito (1993) suggests, fol owing a meta-analysis of 33
studies using nicotine gum in different combinations with cognitive and behaviour
therapy, that the real advantages of nicotine replacement is as an aid to other methods
of smoking cessation, rather than as a 'stand-alone' treatment.
Before looking at the comparative merits of different smoking cessation strategies let us
attempt to make a comprehensive lists of these strategies.
There are other pharmacological treatments available for smoking cessation, apart from
nicotine, which basical y work thorough Yeplacement, blockade, withdrawal relief or
making intake aversive' (see Hughes 1993:751). Law and Tang (1995) reviewed 10
trials of clonidine hydrochloride (which acts to reduce the acuteness of withdrawal
symptoms in a range of drugs) and found that the average quit rate for the 1082
subjects included in these trials was 10%. If trials which did not use biochemical
markers are excluded the quit rates declines to 7%. The same authors reviewed 4 trials
(687 subjects) using silver acetate gum or spray (which creates an unpleasant taste in
the mouth when it reacts with compounds of nicotine). The quit rate using this technique
was 4%. Chockalingam & Schmidt (1992) found that 18% of subjects (from 29 studies
Zyban is a drug which has recently come onto the market in the UK; Jorenby et al
(1999) found quit rates of around 18% with Zyban, and 22.5% with Zyban and a
nicotine patch combined. Some researchers have argued that there are issues to do
with side-effects from Zyban which have yet to be resolved.
Smoking cessation interventions by GPs, nurses and dentists have been cited in the
research; these vary widely in nature, duration and effectiveness and may involve in-
patient or out-patient subjects. There is no standardisation in terms of the type of
intervention made, making it difficult to compare results across studies. The Department
of Public Health & Policy (1992:4) states that:
‘.brief advice in one study may be defined as the usual anti-smoking advice given
by the doctor, which wil obviously vary between doctors, whereas in another study,
the doctors are asked to fol ow a definite protocol. Interventions are frequently
combined so it is not possible to assess the relative effectiveness of different
Richmond et al (1986) shows a quit rate of 35% fol owing detailed advice and for fol ow
up meetings between the smoker and the GP, however most studies give much lower
figures. Law and Tang (1995), in a review of 27 trials involving over 20,000 subjects
found that between 2% and 5% of smokers had quit at 6 months after receiving advice.
In summary it can be said that interventions from GPs, nurses or dentists, in whatever
permutation, may have a positive effect but it is an approach which is likely to be
effective only for a minority of the smoking population.
These may take the form of self-help manuals, or other written or audio materials, which
the would-be quitter can use in a time and a place that suits them. They have the
potential advantage of being extremely cheap to produce and distribute (particularly, for
example, via the internet). There is some evidence of a demand for aids to cessation
which are less intensive and can be control ed by the user in terms of where and when
they take place (Fiore et al 1990)5. Curry (1993) carried out a meta-review of 19 studies
in this area and finds that long-terms cessation (i.e. those not smoking 12 months after
treatment) was as high as 38% in one case, although the vast mass majority of
outcomes were between 2% and 10%. Chockalingam & Schmidt (1992) looked at 24
studies (involving 3,585 subjects) and found that the average quit rate for what they
Chockalingam & Schmidt (1992) examined 19 studies (involving 2,992 subjects) and
found an average quit rate of 30%. This contrasts sharply with the review of 8 trials
(2,759 subjects) carried out by Law and Tang (1995) who found an average quit rate of
only 3%. It is likely that the true efficacy of acupuncture lies somewhere between these
Other Methods of Facilitating Smoking Cessation
There are other strategies which have been employed by governmental or health bodies
to try and reduce smoking, including control of advertising and sponsorship, anti-
smoking advertising campaigns and high levels of taxation on cigarettes. These are not
dealt with in this report as the intention is to briefly compare the options which are
available to the individual seeking to stop smoking nicotine products.
The meta-analysis by Law and Tang shows that most forms of smoking cessation
intervention achieved quit rates of less than 10%. The two large reviews of research
(meta-analysis) give smoking quit rates for hypnosis of between 10% and 60%, with a
crude average for both reviews of 30%. An average 'success rate' of just under a third
may not sound particularly impressive but it must be bourne in mind that this is extremely high compared to many other methods of facilitating smoking cessation.Tailored' Hypnosis—Taking it to the Next Level
The results discussed so far indicate that when the bulk of random trials are considered
hypnosis is shown to be the most effective intervention for achieving smoking cessation.
Yet this is only half the story - many of the trials discussed so far have used very brief
sessions, using standardised hypnosis techniques, many have in fact taken place in
group sessions (making it difficult to tailor to each individual's needs) and have not
necessarily been carried out by expert practitioners of hypnosis. If, under these
circumstances, hypnosis can achieve such positive outcomes in terms of enabling
smokers to quit, then what might be achieved using programmes of hypnosis which are
carried out by expert hypnotists and are tailored to the needs of the individual who
Nuland and Field (1970) found an improvement rate of 60% in treating smokerswith hypnosis. The increased effectiveness was achieved by a more personalised
approach, including feedback (under hypnosis) of the client's own personal reasons for
quitting. These researchers also employed a technique of having the client maintain
contact by telephone between treatments and utilized self-hypnosis in addition.
Hal and Crasilneck (1970) developed a 'tailored' approach over a number of years.
They had been looking for a way in which hypnosis could be used as a means of
control ing the habit of cigarette smoking without excessive frustration, craving for
tobacco, and also without substituting some other habit (such as over-eating). They also
wished to find a treatment that was effective in terms of time and money so that it could
be used with the maximum number of people.
Hal and Crasilneck used their technique on a series of 75 consecutively treated adult
male cigarette smokers, most of whom had been referred by physicians, because their
cigarette smoking was complicating some medical problem. Diagnosis included
coronary artery disease, chronic bronchitis, asthma, and Buerger's disease, although
the most frequent medical problem was emphysema.
Their technique, based on trials of various formats over a period of years, consisted of a
screening interview for each patient, during which the personality structure was
investigated. A determination was made as to whether the use of tobacco was serving a
major neurotic need. Those who were found to have extremely severe depression and
those who had psychotic problems, especial y if they were of a paranoid nature, were
usual y excluded. During the screening they answered any questions that the patient
had about the nature of hypnosis. An attempt was made to minimize any unrealistic
anxieties concerning trance induction. Al patients were told that they could later be
seen for psychotherapy should there be other problems besides smoking. Every
attempt was made to encourage the patient to feel free to communicate any discomfort
or disturbance, either during the time of treatment or afterward. Hal and Crasilneck felt
that this greatly decreased the danger of significant substitute symptoms. Fol owing the screening interview, patients were then seen for four hypnotic
sessions. The depth of hypnosis gradual y increased with the repeated inductions,
even though depth of trance did not necessarily correlate with effectiveness of
“You wil not crave excessively for a habit negatively affecting your health.'
'Your mind can block the perception of discomfort, as when your finger felt insensitive to
the pressure of the sharp nail file . Your mind wil function in such a manner that you
wil nolonger crave for a habit that has negatively affected your life with every drag of
cigarette smoke you have taken into your lungs. . . You wil block the craving for
tobacco . a habit that is causing your heart and your lungs to work much harder than
necessary, forcing your lungs to labor beyond al necessity, stressing and straining
these vital organs . . . like a car constantly driven in low gear. . . constantly laboring
uphil . . . stressing and straining the motor. . . But because of the great control of your
unconscious mind, the craving for this vicious and lethal habit wil grow steadily and
markedly less until it rapidly reaches a permanent zero level. . . You simply wil not
crave for cigarettes again. . . . You wil be relaxed and at ease, pleased that you are
giving up a habit which has such a negative effect upon your life and wel -being. . . You
are improving your life by giving up cigarettes and you wil continue to do so. You
w/y/not smoke cigarettes again. . . You wil not be hungry or eat excessively . . . your
craving wil reach a permanent zero level."
After each use of hypnosis the patient was encouraged to discuss unusual dreams,
thoughts, or feelings that he might have experienced.
The first three hypnotic sessions were given on consecutive days. Between the third
session and the fourth, which was scheduled one month later, the patient was
instructed to cal the office daily for the first week, twice the second week, and then
once a week until the fourth induction of hypnosis. In some cases, where reinforcement
was deemed very important, the patient was asked to cal daily for the entire month.
The patient was told that each cal would reinforce the posthypnotic suggestion and
increase his resistance to smoking. This telephone report was usual y given to a
secretary, though they talked to the patient directly if there was some unusual difficulty.
They requested that each patient walk at least one mile each day as a means of
decreasing tension and improving pulmonary ventilation. If the patient wished, other
forms of exercise might be substituted. Each patient returned one month after the third
induction for their last hypnotic session.
A questionnaire was sent to the 75 patients to determine if they were stil non-smokers.
Al subjects who received the questionnaire had gone at least one year beyond their last
visit, although the range between the last hypnotic session and the time of sampling
varied between one and four years, with a mean of 26 months. In addition to the
structured questionnaire, spontaneous comments were solicited; anonymity was
suggested if it would permit the respondent to be more frank
Of the 75 questionnaires sent, 67 were returned, an 89% response rate. Of those
responding, 82% had not smoked cigarettes at all since the fourth reinforcement session. Of these, 78% had not substituted any 'oral habit'. Of those who had
substituted, however, no substitute seemed as serious as the previous habit of
cigarettes. Several who substituted indicated that they now smoked cigars or a pipe or
had begun to chew gum regularly. The cigar smokers uniformly claimed not to inhale
smoke. Of the total group, 64% were no longer smoking, nor substituting any other oral habit.
Some 18%, however, had continued smoking at the pre-treatment rate. The remaining
18% were not smoking cigarettes; they had substituted another oral habit, usual y of the
comparatively innocuous type previously mentioned.
Prior to treatment these men had smoked cigarettes for a mean time of 27 years, with
an average consumption of forty cigarettes per day. Over 90% had made major
previous efforts to stop smoking, but their average length of abstinence before
treatment was only one week. Of those who successful y discontinued smoking, only
3% felt that they stil had a definite craving for tobacco, although 14% had an occasional
desire; 83% felt that they had no further desire for tobacco. Since many patients had feared that giving up smoking would lead to overeating and
weight gain, it was encouraging to find that the average weight gain had been only four
pounds. This may have been the result of including an explanation in the waking state
that when smoking was stopped, food would begin to taste better. The patients were
cautioned that this improved taste might tempt them to eat more. Instead, it was
proposed that in both the hypnotic and the waking states they eat the same amount of
food as before but enjoy more thoroughly the improved taste.
Those who had resumed smoking and were considered treatment failures had usual y
gone back to cigarettes fol owing some traumatic incident involving frustration or anger.
None reported that they later had quit smoking once they had spontaneously resumed
the habit. None of the questionnaires indicated any psychological disturbance, in either
the structured questions or the free-response comments. Most comments were of
appreciation, were void of hostility, and seemed to emphasize a sense of pride and self-
esteem at having accomplished a worthwhile goal.
Kline (1970) examined the use of extended group hypnotherapy for aiding smoking
cessation. He conceptualized smoking as a dependence reaction, similar to drug
addiction in structure. In one of his therapy groups polygraph recordings were taken as
wel as recordings of upper thoracic respiratory excursions. Before treatment (smoking)
tracings were slower and more regular and lower in amplitude than after the patients
had refrained from smoking for 12 hours prior to hypnotic treatment, at which time the
tracings were slower, wider in amplitude, and more erratic. After the group treatment
using hypnosis, tracings were again as calm as in the pretreatment recordings, though
the patients were now not smoking. Kline concluded that the hypnotic treatment objec-
tively helped to decrease the discomfort associated with withdrawal from smoking. Kline
reported that a 12-hour group therapy session, utilizing hypnosis and other techniques,
was successful in controlling smoking in 88% of those treated.
Von Dedenroth (1968) devised an innovative unique approach which appears to have
been extremely successful. He began by inquiring how long the individual had smoked,
whether they recal ed why they had begun, whether they had ever tried to stop
smoking, why they wanted to stop smoking at this particular point in time, what benefit,
if any, they felt that they derived from smoking, at what specific times they felt the need
most strongly (after meals, before breakfast etc.), and final y he asked them how many
cigarettes they smoked. Von Dedenroth believed that answering these questions not
only tended to increase rapport but also revealed, at least in part, the smoker's own
feelings regarding his smoking and his reasons for wanting to give up the habit. The
therapy proper did not begin until the second session, and at this time the smoker was
told that 'Q Day ' or 'Quitting Day' would be 21 days from that point. The smoker was
also told to change his favourite brand of cigarettes and resolve to never smoke that
brand again. The smoker is then told that they are not to smoke at al :
3. For 30 minutes before retiring The smoker was told that, at the times mentioned above, he was to get into the habit of
going to the bath-room, gargling with mouthwash and cleaning his teeth. He should
have a glass of fruit juice upon awakening and he was told to notice the fresh feeling in
his mouth in the morning and fol owing each of these routines. After his breakfast, he
was to clean his teeth again and use the mouthwash, paying close attention to the clean
feeling in his mouth. Thirty minutes later he was al owed to have a cigarette, but not
before. This tended to break the association between the taste of food and the
inevitable cigarette that usual y fol owed a meal. He was also told to get a smal note-
book to carry with him, and to write down, from time to time, his reasons for giving up
smoking (physical, financial and personal). Then a trance state was induced and the
above suggestions, given in the waking state, were repeated and consequently greatly
reinforced. Fol owing the trance, the patient was encouraged to ask questions, and the
The third session occurred around one week later (and a week before ‘Q' day) - in this
session the smoker was told that they should not drink alcohol at al , or at least to drink
alcohol only with meals, with the intention of breaking the association between alcohol
and smoking. A trance state is again induced and al the previous instructions
reinforced. It is also suggested that smoking wil no longer be enjoyable. In particular
the smoker was told that the first puff of a cigarette may be enjoyable, the second less
enjoyable, and the third may possibly irritate the nose, throat or chest. The aim of this is
that by the time 'Q Day' arrives the smoker may only be taking a few puffs of each
cigarette a day; as the number of cigarettes smoked, and the amount of each of those
cigarettes smoked, has declined, then it should be less painful for the individual to quit. Von Dedenroth believed that the fact that the individual is able to reduce and stop
smoking (with the aid of hypnosis) gives the individual a great feeling of self-
accomplishment. 'Q day' begins with the induction of a trance state and it is
emphasised continual y to the smoker that bad habits have been replaced by good
ones, and that for several weeks cigarettes have become more and more unpleasant. The study by Von Dedenroth, described above, has the highest quoted success rate for
hypnosis in achieving smoking cessation which has been reported in the literature to
date; Von Dedenroth found that his use of hypnosis enabled 94% of 1000 subjects to stop smoking (when checked at 18 months).
In the next section a study carried out in 2000, involving the use of hypnosis to aid
smoking cessation, is examined. The findings presented here, of the study carried out
by Practice Builders, show that the standard therapy they used and what they have
termed 'advanced therapy' both have success rates considerably above what has been
Practice Builders Study (2000)
This research was carried out on 300 subjects (beginning in January 2000 and
continuing until March 2002)6 who responded to an advertisement. A 'blind trial'
technique was used - subjects were not aware that they were taking part in a research
project although they al ticked a box on their intake forms saying that they understood
that the hypnotist's methods were always being measured tested and improved, and
that results would be col ated and studied. Client confidentiality was assured so that
their data could be used but not their names and these subjects were randomly
al ocated to receive either 'standard' hypnotherapy or a special formulation of
hypnotherapy which Practice Builders has termed 'advanced therapy'. 51% of
respondents were male and 49% female; the median age of al subjects was 44 years. No respondents had previous experience of hypnosis - 51% of subjects had tried
nicotine patches, 14% had tried nicotine gum, 7% had tried acupuncture, 6% had tried
using a nicotine inhaler and 30% had previously tried to quit using wil -power alone.
11% of subjects had not previously tried to quit smoking. For al subjects: The client was interviewed to make sure that they wanted to stop smoking for their own
reasons, and were not being pressured into it by someone else (doctor, loved one etc.). The price was kept high (£250) to establish commitment, and to avoid people who were
casual y or speculatively trying hypnosis (as opposed to those who have some
commitment, confidence or belief that hypnosis would help them to stop smoking). Al subjects waited a minimum of three weeks for an appointment in order to build
expectancy - subjects were already thinking about, and planning being, a non-smoker
for weeks before the treatment began. Before the actual hypnosis, the client (or subject) is asked a series of questions about
their smoking habit and their beliefs. This al ows the hypnotherapist and the client to
build rapport and also lets the hypnotherapist become aware of any thought patterns
based on myths or misconceptions that need to be cleared up before the hypnosis.
They are asked, for example: 'Do you believe you are addicted to nicotine?’
'What fears do you have about stopping?'
‘What do you know about hypnosis?’ Hypnosis was then ful y explained to the client, as wel as how the conscious and the
unconscious mind works, and any myths debunked (such as, you cannot make
someone do something they don't want to do, hypnosis is not sleep or
unconsciousness, you wil be aware of everything that is going on and wil remember
everything that happened in hypnosis after the session, you can stop the session at any
time, etc.). This is cal ed the "pre-talk".
6 These clients were seen by Dr. Barry Neale, Ph.D. in his practice, The Accelerated Change Centre
A hypnotic contract is then entered into, in which the client agrees to go along with al
techniques and to accept al the suggestions that are for their benefit. For subjects treated with the standard technique: The client then reclines in the chair, and a basic stop smoking script is read. This type of
standard technique doesn't al ow for much in the way of personalising a session, as it is
the same for every client. The wording of some of the best basic techniques uses
hypnotic language patterns (Neuro Linguistic Programming). The client is then
emerged. For subjects treated with the advanced technique: Hypnosis is induced using a progressive test induction tailored to the client. Ideo motor
techniques are used to gain unconscious communication. The client's own motivations,
Meta programmes, and values are utilised in the session using a combination of
metaphor and suggestion. NLP sub-modality and anchoring techniques are used
according to the client's processing style. At the end of the session, the client is
emerged from hypnosis and the change is tested, then future paced and ratified. Findings Quit rates were established thorough telephone interviews 1 month and 6 months after
the first session of treatment. After 1 session 95% of those who received ‘advanced therapy’ had quit smoking.
The remaining 5% received a second session of treatment leading to a further 1.3% of
the group quitting smoking. In total therefore, at 6 months, 97% of those who received
'advanced therapy' had quit smoking. Of those who received 'standard therapy' 51% quit smoking after one session and a
further 6% quit after a second session—a total of 57% had quit smoking at 6 months. Those who were stil smoking at 6 months did not differ from those who had
successful y quit in terms of gender, age or therapies previously tried. These results
mean that for both standard treatments and the 'advanced treatment' quit rates are
extraordinarily high and wel above what has hitherto been reported in the literature.
Results for both treatments were significant at the 0.001 level (chi-square). Outcomes for the 'advanced therapy' are considerably higher than any findings
previously reported in the literature. In addition, the success rate achieved using the
standard technique was considerably higher than expected and this may be due to the
fact that the elements that the standard treatment and 'advanced treatment' have in
common (price, waiting period for the session, advertising exposure, and pre-talk etc.)
Conclusions
As the evidence which has been presented demonstrates, hypnosis would seem to be
one of the most effective methods in aiding smoking cessation (and arguably the most
effective). The study carried out by Practice Builders achieved quit rates very close to
100% and indicated what can be achieved with hypnosis when it is appropriately
tailored to the individual seeking help to quit smoking. Given the apparent superiority of hypnosis as a smoking cessation intervention it is
worth considering why hypnosis is not more widely used and, in particular, why the NHS
and its international equivalents have not attempted to promote or subsidise
hypnotherapy to any significant degree. Some of the possible reasons for this are
There are a variety of methodological issues in relation to many smoking cessation
studies and these are not restricted to those studies looking at the use of hypnosis.
‘.a serious problem with the studies reviewed was the overal lack of consistency
across research teams regarding what and how variables were measured. This
was mainly manifested in the description of the subjects' characteristics and
smoking histories, the great diversity of cutoff values used to validate abstinence
within each of the biochemical verification methods, the various definitions of
abstinence, and the specificity with which the experimental procedures were
The Department of Public Health & Policy (1992:2) point out that:
'Studies of smoking cessation interventions have traditional y been plagued by
inadequate sample sizes. In order to detect clinical y meaningful differences in
outcome between intervention and control groups, and therefore attribute
cessation rates to the intervention rather than other factors, a minimum of 100
Further methodological problems of smoking cessation studies are outlined by
Chockalingham and Schmidt (1993) and Berglund et al (1974) who draw attention to the
problem of non-response during the fol ow-up to studies. Most of the primary studies
are based on participants who reply to fol ow-up cal s or questionnaires - it may be that
these people disproportionately represent the successful quitters, which would result in
a response bias. It is quite possible that there may be a social desirability effect
pertaining to people who are simply asked if they have refrained from smoking over a
given period - they may want to give the answer which they perceive the interviewer
would like them to give. Chockalingam and Schmidt suggest countering this through
comparing the quit rates of the experimental and control groups (rather than just quoting
the quit rate of the experimental group). Response bias can be countered by assuming
that those not contacted have in fact started smoking again (this is basical y a way of
However, the only way to be sure about whether or not individuals have given up
smoking is through the use of blood tests. Lando (1989) found that in studies using self-
reports of cessation, 25-28% of subjects who had claimed to have stopped smoking are
in fact found to be smoking when their smoking status is validated using biochemical
In some, if not al studies of smoking cessation through hypnosis, there is no use of
biochemical markers (blood tests) in fol ow-up. This may be because such studies are
conducted by people who haven't been trained in a classical 'medical paradigm'.
Nonetheless, if comparisons of hypnosis and other methods are to be valid then there
needs to be standardisation of methods and procedures. There was great variability in the range of results from the meta-analysis carried out by
Chockalingam (1992) and that carried out by Law (1995). This confirms the points made
earlier in this paper about the difference between a 'bespoke' program of hypnosis and
very general hypnotic procedures carried out under less than ideal conditions. In other
words it may be that even 'basic' hypnotic techniques are very effective in helping
people to quit smoking but that the real power of hypnosis can only be released in the
hands of skil ed practitioners who are sensitive to the needs of their clients. Research is
obviously required to isolate those techniques and procedures that are particularly
It is worth noting that sections of what might be termed the 'western medical
establishment' is biased towards 'medical' treatments and against 'alternative' therapies
(which is how many would see hypnosis). Although there is some progress in changing
old prejudices against non-pharmacological interventions there is stil much
One other factor may be that, although it would seem that hypnosis has a higher rate of
effectiveness in achieving smoking cessation than other types of intervention, this does
not mean that there wil necessarily be a high take up of hypnosis amongst the public,
even if it were to be subsidised or made free. Unlike a nicotine patch, hypnosis does
require a certain amount of commitment from participants and it is certainly the case
that many people stil associate hypnosis with being out of control or somehow making
If hypnosis is to be adopted as a 'mainstream' treatment for smoking cessation then it
wil be necessary at some stage for hypnosis to prove itself within the medical paradigm
of the health establishment in the UK and elsewhere. This could best be done by large
randomised clinical trials and, crucial y, these trials should adopt a methodology of
confirming smoking cessation through the use of biochemical markers (i.e. blood tests)
as this is one of the most frequently raised chal enges to the high rates of success
which appear to pertain in relation to hypnotherapy for smoking cessation. Final y, it is worth bearing in mind that individuals have different needs and desires in
terms of the smoking cessation therapy which is suitable for them. Shiffman (1993: 719)
argues that, The era of the single-approach program is over. Smoking cessation has
come to be dominated by multi-component, al -inclusive programs that combine
elements of many approaches.' It is perhaps time that hypnosis moved from being
considered an alternative therapy to being used as a key part of a national smoking
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